independent payment advisory board - florida neurosurgical update - fns … · house e&c bill...
TRANSCRIPT
![Page 1: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/1.jpg)
Washington Update Florida Neurosurgical Society
Meeting
Katie O. Orrico, Director AANS/CNS Washington Office
![Page 2: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/2.jpg)
Presentation Overview • Health Reform
• Reimbursement
• Communications
• Political Action
![Page 3: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/3.jpg)
Reforming the Reform
• Addressing Omissions: • SGR Fix
• Including private contracting • Medical Liability Reform • Workforce Shortages/GME
• Correcting Commissions: • IPAB Repeal • Quality Penalties • Medical Device Tax Repeal
![Page 4: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/4.jpg)
![Page 5: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/5.jpg)
Moving Forward w/Implementation
![Page 6: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/6.jpg)
7-feet of regulations — over 20,000 pages and growing!
![Page 7: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/7.jpg)
![Page 8: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/8.jpg)
![Page 9: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/9.jpg)
Medicare’s UnSustainable Growth Rate
Congress continues w/short-term “patches” to fix Medicare’s sustainable growth rate (SGR)
• 27% pay cut on Jan. 1, 2014 (w/sequester)
• Cost of Repeal = $139.1 billion ($100 less than previous estimates!)
![Page 10: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/10.jpg)
Top 10 Principles for SGR Reform • Repeal the SGR
• At least 5-year period of payment stability w/annual updates based on MEI
• No pay update differentials between PCPs and specialists
• Choice of voluntary payment models…must maintain a viable fee-for-service option
• Allow private contracting on case-by-case basis
• Positive incentives, rather than penalties, for quality improvement
• Replace current PQRS, EHR, VBPM programs if new quality-based payment system adopted
• Quality measures determined by physicians
• Legal protections for physicians following guidelines and participating in quality programs
• Repeal IPAB
![Page 11: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/11.jpg)
BUT, be careful what we ask for…
SGR Fix
![Page 12: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/12.jpg)
House E&C Bill Phase I:
• Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year = 0.5%
Phase II: • New Quality Update Incentive Program (UIP); Annual
update each year = 0.5% • Quality measure sets & clinical practice improvement
activities for each “peer cohort” (e.g., neurosurgeons); Developed by specialty societies
• Coordinated w/ PQRS (need to clarify qualified clinical data registry program language); Future potential integration w/EHR-meaningful use program
![Page 13: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/13.jpg)
House E&C Bill Phase II (cont’d):
• Quality rating system: scoring scale of 0 to 100; Methodology must be risk-adjusted; Payments based on composite score: − Score of 67 or higher: +1% bonus − Score of 34-66: zero payment adjustment − Score below 34: -1% penalty
• No PQRS penalty if MD participates in UIP; EHR program penalties (-5%), VBPM adjustments (-2%) still apply
• 5% pay cut for MDs who do not participate in UIP
New Payment Model Choice Program: Alternative Payment Models (APMs); MDs can participate in lieu of UIP
![Page 14: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/14.jpg)
House E&C Bill Miscellaneous provisions:
• Development of episodes of care and bundled payments for high volume services
• MDs must report data (volume & time) on the accuracy of RVUs
• In 2016-2018, CMS will identify misvalued services; Medicare spending cut by up to 1% per/yr.
Medical liability protections: Federal healthcare guidelines & quality standards do not establish a standard of care in medical malpractice claim
![Page 15: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/15.jpg)
Evaluation of House E&C Bill Reform Principle Yes No So So
Repeal SGR X 5-year period of payment stability X Payments based on MEI X No pay differentials for specialists & PCPs X Choice of payment models X Viable fee-for-service option X Private contracting X Positive incentives for quality improvement X Replace current PQRS, EHR, VBPM X Quality measures developed by physicians X Legal protections for physicians X IPAB Repeal X
![Page 16: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/16.jpg)
E&C Proposal: Base Payments Fail to Keep Pace w/Inflation
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Payment Update MEI
![Page 17: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/17.jpg)
Some Concerns w/Alternative Models • ACOs do not easily incorporate surgeons and other
specialists
• Defining episodes of care extremely difficult
• Hospitals and/or PCPs, rather than specialists, will dictate patient care based on payment model, rather than clinical need
• Hospitals and PCPs will dictate how to divide the pie
• Shaving costs may mean eliminating certain implants and other devices from surgeons’ toolbox
• Potential for cherry-picking, limiting access to care for very sick patients
![Page 18: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/18.jpg)
Other Payment Reform Options • House/Senate introduced Medicare Patient
Empowerment Act (MPEA) – H.R. 1310/S. 236 • 16 cosponsors (House); 3 cosponsors (Senate)
• Allows docs and patients to privately contract on case-by-case basis
• No Medicare opt-out
• Hospital other fees still paid www.MyMedicare-MyChoice.org
![Page 19: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/19.jpg)
Sign the
Petition www.MyMedicare-MyChoice.org
Contact Congress
http://capwiz.com/noc/
![Page 20: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/20.jpg)
Next Steps • Congressional Budget Office unveils “score” of
E&C bill
• House Ways and Means and Senate Finance Committees drafting their versions • Revealed in late Sept./early Oct. • Both will incorporate enhanced quality reporting
requirements
![Page 21: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/21.jpg)
Outlook for SGR Repeal Potential Challenges: • Lack of bipartisan consensus on replacement
policy (so far so good) • Price tag for repeal and replace ($140-200b) • Inability to find bipartisan budget offsets • Legislative vehicle uncertain • A lot to do in less than 4 months
Best Guess: Another year-end scramble to pass a short-term “fix”… but we are NOT GIVING UP!
![Page 22: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/22.jpg)
Continuing the Fight for Medical Liability Reform
![Page 23: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/23.jpg)
This is an actual picture from a bench in Pittsburgh, PA
The Trial Bar Never Stops!
![Page 24: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/24.jpg)
Federal Legislation S. 44, Medical Care Access Protection Act • 2 cosponsors • Texas-style stacked cap ($250,000 each provider; max
$500,000 total); expert witness requirements; limits on attorney contingency fees; periodic payment of damages
Rob Portman (R-OH)
![Page 25: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/25.jpg)
Federal Legislation H.R. 36/S. 961, Health Care Safety Net Enhancement Act • 64 cosponsors (House); 1 cosponsor (Senate) • Extends Federal Tort Claims Act liability protections to
physicians serving on-call to the hospital emergency department
Charlie Dent (R-PA)
Roy Blunt (R-MO)
![Page 26: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/26.jpg)
Federal Legislation H.R. 1733, Good Samaritan Health Professionals Act • 15 cosponsors • Limits the liability of physicians who volunteer to
provide health care services in response to a declared natural disaster
Marsha Blackburn (R-TN)
![Page 27: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/27.jpg)
Federal Legislation H.R. 1473, the Standard of Care Protection Act • 11 cosponsors (but included in E&C SGR bill) • Clarifies that lawsuits cannot be based on whether physicians
followed national guidelines or payment policies (e.g., PQRS) created in federal health care laws
Phil Gingrey, MD (R-GA)
Henry Cuellar (D-TX)
![Page 28: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/28.jpg)
Recent State Victories
Florida – SB 1792 • Requires an expert medical witness to be in the same
specialty as the defendant physician
Georgia – Provider Shield Act (HB 499) • Payor guidelines and criteria under federal law (e.g.,
PQRS) shall not establish legal basis for negligence or standard of care for medical malpractice
But… California’s MICRA is AT RISK
![Page 30: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/30.jpg)
IOM Study Overview Institute of Medicine Review will: 1) assess current regulation, financing, content,
governance, and organization of U.S. GME; and 2) recommend how to modify GME to produce a
physician workforce for a 21st century U.S. health care system
Study Timeline: • Start Date: June 2012 • Public meetings held in Sept & Dec • Draft report Summer/Fall 2013 (for peer review) • Final Report Winter 2013-14
![Page 31: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/31.jpg)
Government Accountability Office (GAO) Reports
• Requested by Sens. Tom Coburn (R-OK), Michael Enzi (R-WY) and Richard Burr (R-NC)
• GME Funding Review: • Complete list of federally funded GME and loan
forgiveness programs • Evaluation of return on investment and possible
duplication • Description of all programs available in mid-2013
![Page 32: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/32.jpg)
Government Accountability Office (GAO) Reports
• Workforce Report Objectives: • Recent supply trends, including info on training
and demographics • Projections of future supply and factors affecting
projections • How provisions in ACA may affect future
workforce needs
![Page 33: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/33.jpg)
GME Legislation
Bill Nelson (D-FL)
Charles Schumer (D-NY)
Harry Reid (D-NV)
S. 577: Resident Physician Shortage Reduction Act • 9 cosponsors • Funding for additional 15,000 slots – 3,000 per year
• 1/3 for a “cap-relief pool”; 2/3 for “priority pool” • 50% for primary care; 50% workforce shortage specialties
• Nat’l Health Care Workforce Commission study
![Page 34: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/34.jpg)
GME Legislation H.R. 1180: Resident Physician Shortage Reduction Act • 63 cosponsors • Funding for additional 15,000 slots – 3,000 per year
• 1/3 for a “cap-relief pool”; 2/3 for “priority pool” • 50% for primary care; 50% workforce shortage specialties
• Nat’l Health Care Workforce Commission study
Joseph Crowley (D-NY)
Michael Grimm (R-NY)
![Page 35: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/35.jpg)
GME Legislation H.R. 1201: Training Tomorrow’s Doctors Today Act • 41 cosponsors • Funding for additional 15,000 slots – 3,000 per year
• 1/3 for a “cap-relief pool”; 2/3 for “priority pool” • 50% for primary care; 50% workforce shortage specialties
• 2% IME penalty unless comply w/ ACGME measures • GAO study on shortages; HHS reports on GME funding
Aaron Schock (R-IL)
Allyson Schwartz (D-PA)
![Page 36: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/36.jpg)
GME Legislation H.R. 297, Children’s Hospital GME Support Reauthorization Act • Authorizes $330 m/yr for FY 13-FY 17
(for 55 hospitals) • Passed House of Representatives on
Feb 4, 2013; Pending action in Senate
Yeas Nays NV Republican 171 49 11
Democrat 181 1 18
Total 352 50 29
![Page 37: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/37.jpg)
![Page 38: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/38.jpg)
Independent Payment Advisory Board
• What is the IPAB? • 15 member, government board • Sole purpose: cut Medicare • Limited Congressional oversight • No judicial review • Hospitals exempt from cuts until 2020 • Cuts on top of SGR and other Medicare cuts
![Page 39: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/39.jpg)
IPAB Repeal Physician IPAB Repeal Coalition
• Neurosurgery & Anesthesiology leading effort
• 26 National Specialty Societies, representing 350,000 physicians
• Activities include: • Letters/visits to Congress • Grassroots • Op Eds/Letters to the Editor
• Coordinating with larger IPAB Repeal efforts (PhRMA, HLC, patient groups)
![Page 40: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/40.jpg)
IPAB Repeal Protecting Seniors' Access to Medicare Act
(H.R. 351/S. 351)
Phil Roe, MD (R-TN)
Allyson Schwartz (D-PA)
House Bill 192 cosponsors
170 Rs; 22 Ds
Senate Bill 36 cosponsors
34Rs; 2 Ds
John Cornyn (R-TX)
![Page 41: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/41.jpg)
IPAB Repeal Legislation • Vote in House in Sept (part of ACA repeal efforts)
Litigation • Coons v. Geithner (filed by Goldwater Institute)
• Alleges IPAB violates separation of powers doctrine
Communications • Op Eds & Letters to the Editor
AANS/CNS Letter
Published
![Page 42: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/42.jpg)
The Quality Penalties are Coming! The Quality Penalties are Coming!
2015 BUT CMS started the clock in 2013!
![Page 43: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/43.jpg)
Total 10-yr Payment Adjustment
SGR Deficit
Reduction Sequester
PQRS e-Rx EHR
Value Based
Payment Modifier
2013 -2 -1.5
2014 -24.7 -2 -2
2015 3.6 -2 -1.5 -1 -1
2016 2.6 -2 -2 -2 -2
2017 2.0 -2 -2 -3 ?
2018 1.5 -2 -2 -3 ?
2019 1.0 -2 -2 -4 ?
2020 0.9 -2 -2 -5 ?
2021 1.0 -2 -2 -5 ?
2022 1.3 -2 -2 -5 ?
TOTAL = 80%Cut!
Does not include IPAB and other Medicare Fee Schedule cuts)
![Page 44: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/44.jpg)
Medical Device Tax Repeal • Amendment to Senate Budget: Passed 79 to 20 • Medical Device Access and Innovation Protection Act
(S. 232) • Protect Medical Innovation Act (H.R. 523)
House Bill 260 cosponsors
Senate Bill 35 cosponsors
Orrin Hatch (R-UT)
Amy Klobuchar (D-MN)
Eric Paulsen (R-MN)
Ron Kind (D-WI)
![Page 45: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/45.jpg)
Future Uncertain Given Current State Government!
![Page 46: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/46.jpg)
Other Payment Issues • Third Party Coverage Policies: Rapid Response
Team • BMP • Lumbar & cervical spine fusion • TENS for chronic low back pain • Minimally invasive lumbar interbody fusion • Stereotactic radiosurgery • Surgical and ablative treatments for chronic headaches • Management of carotid atherosclerosis • Mechanical embolectomy
• ICD-10: Implementation Oct. 1, 2014
![Page 47: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/47.jpg)
![Page 48: Independent Payment Advisory Board - Florida Neurosurgical Update - FNS … · House E&C Bill Phase I: • Repeals SGR; 5 year payment stability: 2014-18 • Annual update each year](https://reader035.vdocument.in/reader035/viewer/2022081404/5f05ad997e708231d41427a7/html5/thumbnails/48.jpg)
Political Action • Raised $180,000 in 2013
• $21,175 from Florida NS: THANK YOU!
GOAL: $250,000
• Contributed $188,000 thru 6/30/13
Please contribute!
Democrat Republican Number Amount Number Amount
Individuals 5 $12,000 Individuals 40 $131,000
Political Party 0 $0 Political Party 6 $45,000
TOTAL 5 $12,000 TOTAL 46 $176,000